AHRQ Stats: Most Expensive Hospital Conditions

The five most expensive conditions for hospital treatment in 2013 were septicemia; osteoarthritis; care for newborn infants; complication of device, implant or graft; and acute myocardial infarction. These conditions accounted for about 20 percent of total hospital costs. (Source: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project Statistical Brief #204: National Inpatient Hospital Costs: The Most Expensive Conditions by Payer, 2013.)

National Inpatient Hospital Costs: The Most Expensive Conditions by Payer, 2013

Celeste M. Torio, Ph.D., M.P.H., and Brian J. Moore, Ph.D.

Introduction

Health care expenditures have maintained a relatively stable share of the Gross Domestic Product since 2009, reaching 17.5 percent in 2014.¹ Hospital care expenditures in particular, which constitute the largest single component of health care spending, grew 4.1 percent in 2014.² Although this is up from 3.5 percent in 2013, annual hospital care expenditure growth averaged 5.5 percent from 2008 through 2012.³ Policymakers are among those concerned with the burden of medical care expenses to governments, consumers, and insurers. Although only 7.2 percent of the U.S. population had a hospital inpatient stay in 2012, the mean expense per stay associated with those hospitalizations was over $18,000, making hospitalization one of the most expensive types of health care treatment.^4,5

This Statistical Brief presents data from the Healthcare Cost and Utilization Project (HCUP) on costs of hospital inpatient stays in the United States in 2013. It describes the distribution of costs by expected primary payer and illustrates the conditions accounting for the largest percentage of each payer's hospital costs. The primary payers examined are Medicare, Medicaid, private insurance, and uninsured. The hospital costs represent the hospital's costs to produce the services—not the amount paid for services by payers—and they do not include the physician fees associated with the hospitalization.

Findings

Aggregate hospital inpatient costs and stays by payer, 2013
Figure 1 presents the distribution by expected primary payer for aggregate hospital costs and total hospital inpatient stays in 2013.

Highlights

In 2013, aggregate hospital costs for 35.6 million hospital stays totaled $381.4 billion.

The five most expensive conditions—septicemia; osteoarthritis; liveborn (newborn) infants; complication of device, implant or graft; and acute myocardial infarction—accounted for approximately one-fifth of the total aggregate costs for hospitalizations. The top 20 conditions accounted for nearly half of aggregate hospital costs.

The primary payer shares of aggregate hospital costs were 63 percent for Medicare and Medicaid, 28 percent for private insurance, and 5 percent for uninsured hospitalizations.

Septicemia ranked among the four most costly conditions in the hospital for all four payer groups.

Hospitalizations associated with pregnancy and childbirth accounted for 5 of the 20 most expensive conditions for hospital stays covered by Medicaid.

Mood disorders was a top-ranked condition for stays covered by Medicaid and private insurance and for uninsured stays.

Figure 1. Aggregate hospital costs and hospital stays by payer, 2013

Source: Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project (HCUP), National Inpatient Sample (NIS), 2013

Figure 1. Aggregate hospital costs and hospital stays by payer, 2013. Figure 1 is a stacked bar chart that shows the percentage of aggregate hospital costs and hospital stays by payer in 2013. Aggregate costs for 2013 were $381.4 billion. Data show the percentage of aggregate hospital costs by payer: Medicare: 46%, Medicaid: 17%, Private insurance: 28%, Uninsured: 5%, Other/missing: 4%. Hospital stays totaled 35.6 million in 2013. Data show the percentage of hospital stays by payer: Medicare: 39%, Medicaid: 21%, Private insurance: 30%, Uninsured: 6%, Other/missing: 4%.

In 2013, Medicare accounted for the largest proportion of aggregate hospital costs (46 percent).

Patients with primary Medicare coverage accounted for 46 percent of the $381.4 billion in aggregate hospital costs in 2013. Private insurance was the second most common payer, accounting for 28 percent of total costs, followed by Medicaid with 17 percent of costs. Stays of uninsured patients represented 5 percent of total hospital costs. Government payers (Medicare and Medicaid) accounted for 63 percent of all hospital costs.

Patients covered by Medicare accounted for a larger proportion of aggregate hospital costs (46 percent) than of hospital stays (39 percent). In contrast, patients covered by Medicaid accounted for only 17 percent of hospital costs but 21 percent of hospital stays.

Most expensive conditions treated in U.S. hospitals, 2013
Table 1 presents the most expensive conditions treated in U.S. hospitals among all payers in 2013.